The Food You Eat Will Decide How You Breathe!

It’s very surprising for most people that the food they eat affects their breathing and health of their lungs. We know that our body uses food as fuel. Also, a single nutrient cannot help us to fulfil our body’s requirements and we need multiple nutrients from all food groups i.e. a healthy and balanced diet.

How food is related to breathing

The process of changing food into fuel is called metabolism. In this process oxygen and food are raw materials and carbon dioxide is waste material which we exhale. Carbohydrate food when catabolised releases maximum amounts of carbon dioxide as compared to fat. So, in case of COPD patients, it sometimes becomes beneficial to eat food with less carbohydrates as it can help to breathe easier.

Our lungs work tirelessly to keep our system going so it is necessary to give importance to proper care of the lungs for proper functioning. Inflammation of lungs makes breathing difficult and leads to congestion. In today’s polluted environment it becomes even more important to focus on one’s nutrition.

Nutrition Recommendations

Diet plays an important role for healthy lungs. Choose complex carbohydrates such as whole grains, fresh fruits, vegetables. If you are obese or overweight, try to lose weight and achieve an healthy BMI. Obesity causes substantial changes to the mechanics of lungs and chest wall which can lead to difficulty in breathing, exercise intolerance and worsening of asthma and  asthma like symptoms. Being Underweight is not directly related to poor lungs health but it leads to weakened immune system which makes you more prone to infectious and communicable diseases. Limit intake of simple carbs like sugars, cakes, soft drinks, candies etc.

Increase the intake of fibres to approximately 20 to 30 g each day. Take a good amount of proteins each day from natural sources, e.g. eggs, milk, meat, fish, nuts, etc. A good intake of protein will help you to make your respiratory muscles strong. Try to take healthy fats like canola oil, rice bran oil, olive oil etc. instead of saturated fats like margarine, butter, ghee, cookies, pastries, hydrogenated fats (like vanaspati ghee) etc.

Avoid foods that cause gas or bloating as they can further lead to difficulty in breathing and uneasiness.

Try to add more fruits and vegetables to your diet as these are rich source of vitamins and mineral which will help you to enhance your immune system and help you fight off chest infections.

Increase the intake of dairy products as these are rich in proteins and calcium. During COPD treatment there are chances of deficiency of calcium.

Try to limit the use of salt as excessive salt intake can cause edema (or swelling of the body) and lead to high blood pressure.

Drink plenty of water to keep yourself hydrated – at least 8 – 10 glasses per day. But in case of pulmonary hypertension consult your physician first on how much fluids you can take.

Consider adding a nutritional supplement at night-time to avoid feeling full during the day.

So adding healthy foods to your diet will give longer life to your organs. Before starting any diet consult your dietician and physician as diet should be tailored to you as per your body’s requirements call us: 0172-4911000, 9779030507.

                                 Eat right with every bite..

   

 

Lung Transplantation for End-stage Lung

An end-stage lung condition is defined as lung destruction leading to extensive respiratory disability and a state of crippling. Such a patient is completely bed-ridden and continuous oxygen dependent. The patients get severely malnourished, lose muscle mass and weight. In recent times, there is a significant increase in prevalence of end-stage lung problems and oxygen dependence especially after the COVID pandemic. Such a condition frequently results from some of the following common conditions:

1.      Extensive post-COVID lung fibrosis

2.      Progressive fibrosing illnesses of the lungs due to interstitial lung diseases

3.      Chronic obstructive pulmonary disease

4.      Vascular Lung Disease,  Primary pulmonary hypertension

5.      Other chronic diseases: Suppurative Lung Disease, Cystic fibrosis,  Bronchiectasis

Patients with end-stage lungs can be helped with several modalities besides the routine drug treatment such as the Respiratory Rehabilitation; Yoga and pranayama therapy; Breathing exercises; Nutrition support and muscle building; Psychological supports

Lung transplantation: Lung transplantation is offered as a last hope for some of such patients available at a few select centres, mostly in South India. Lung transplantation requires a large infra-structure and plan for availability of the organs besides the expertise and the costs.

Patients who are fit for lung transplant need to be carefully selected and undergo preoperative pulmonary physiotherapy and RR so that they can get best results from the transplant

These patients also need a long term post operative physiotherapy and rehabilitation program so that the advantages of transplant can be maintained. They also require regular surveillance for early signs of rejection and other complications with help of blood investigations, radiology, bronchoscopy and biopsies.

Respiratory Problems due to Obesity

Obesity i.e overweight is a common condition the world over, including in India. It is not altogether wrong to say that there is almost an epidemic of obesity particularly noticeable in the developed countries. Even the developing countries are not spared of the menace of over-weight.

Obesity is common among adults as well as children. It is largely attributed to a sedentary lifestyle and excessive use of ‘junk foods’ rich in fats, carbohydrates, and calories. Even though a good weight is surely a sign of a healthy body, overweight is considered as a ‘medical problem’ or even a ‘disease’ in itself. Excessive weight is an unnecessary burden on the body which poses risks for almost all body systems. In particular, it is responsible for muscle and joint problems and diseases of the heart and the lungs.

Effects on the respiratory system

Obesity affects the respiratory system in multiple ways. Some of the important effects are described as under:

•  Lung function:  Lung function is poorer in overweight persons. To a large extent, the lung capacity is adversely affected by excess body weight. Thoracic and lung expansion is restricted due to the mechanical effects of fat on the chest wall and diaphragm in obese people. The clinically significant restriction is generally present whenever there is massive obesity defined by the patient’s weight-to-height ratio of 0.9-1.0 kg/cm or greater. Obese people may complain of breathlessness due to poor lung function even in the absence of definite lung disease.
• Asthma: There is some association of asthma with obesity. Obese asthmatics have more significant symptoms of breathlessness, wheezing, and cough. Moreover, asthma is difficult to control in obese patients. This is particularly worrisome in obese children who present with a severe form of asthma.
• Chronic obstructive pulmonary disease (COPD): COPD is a progressive form of airway obstructive disease which is more commonly seen in smokers. Obesity is usually not a problem with most patients of COPD who often complain of significant weight loss and muscle wasting. Obesity may however be present in patients with chronic bronchitis in whom it will add to the symptoms of breathlessness.
• Obstructive sleep apnea (OSA): OSA is an important problem characterized by intermittent obstruction of the upper respiratory tract especially during sleep. The obstruction occurs due to loss of tone and inability of the pharyngeal muscles during sleep to keep the airways open and thus resulting in its partial closure. It causes momentary cessation of breathing and fall in oxygen saturation, snoring, and other physiological effects. In due course of time, OSA is responsible for hypertension, diabetes, cardiovascular and cerebrovascular diseases.
• Obesity is an important risk factor for OSA, a potentially fatal disease. Patients with OSA tend to fall to sleep within minutes and even while driving resulting in frequent and sometimes fatal accidents. Undoubtedly, OSA is the most serious complication of obesity. Weight reduction is an important component of the treatment of OSA. Mild OSA may even be reversed with the treatment of obesity.
• Obesity hypoventilation syndrome (OHS): OHS is characterized by hypoventilation i.e. decreased (than normal) amount of air entering the lungs with each breath resulting in lower oxygen saturation and increased carbon dioxide pressure in the blood. In the long run, the condition leads to failures of the respiratory and cardiovascular systems. Weight reduction is the most important component of treatment.

Management

Weight reduction is the most significant component of all forms of problems associated with obesity. Dietary control and physical exercise are important but often difficult to achieve.  Frequently, one has to resort to other measures of weight reduction which may include bariatric surgery. The doctor can advise about the type of management required in a case. Standard treatment of the respiratory disease associated with obesity should be done as appropriate for the individual patient.

Diagnosis and management of Interstitial pulmonary fibrosis

The Shrunken Lungs

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Dr Surinder K. Jindal, MD, FCCP, FAMS, FNCCP
(Emeritus-Professor, Postgrad Instt Med Edu & Research,Chandigarh, India)
Medical Director, Jindal Clinics,SCO 21, Sector 20 D, Chandigarh, India 160020
Email: dr.skjindal@gmail.com  Ph. 0172-4911000; 0172 4911100

Websites:  www.jindalchest.com, www.ivfchandigarh.com

Blog: medicalvignettes.blogspot.in

COPD

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Dr Surinder K. Jindal, MD, FCCP, FAMS, FNCCP
(Emeritus-Professor, Postgrad Instt Med Edu & Research,Chandigarh, India)
Medical Director, Jindal Clinics,SCO 21, Sector 20 D, Chandigarh, India 160020
Email: dr.skjindal@gmail.com  Ph. 0172-4911000; 0172 4911100

Websites:  www.jindalchest.com, www.ivfchandigarh.com

Blog: medicalvignettes.blogspot.in

FENO - a new test for asthma

FeNO

FeNO or fraction of exhaled nitric oxide, has emerged in recent years as one of the new tests to diagnose and monitor asthma. Asthma is one of the most common diseases in humans, with children especially afflicted. The diagnosis of asthma is primarily a clinical one and the management too has been based more on the clinical sense of the treating physician. However, with increasing patient populations and more information about new subtypes of asthma, a test was needed to help support the clinician’s diagnosis and management strategy. FeNO has stepped up to meet the gap.

It may come as a surprise to many that the normal lungs produce some amounts of nitric oxide or NO. The amount produced is minuscule though, in parts per billion. In disease states - such as asthma – the amount of NO produced increases significantly. This finding cal be exploited in routine clinical practice to support the diagnosis of asthma and to monitor treatment.

Asthma is mainly of two types – eosinophil predominant and non-eosinophil predominant (eosinophils are a kind of blood cell). The eosinophil predominant type of asthma responds very well to inhaled steroids while the non-eosinophil type does not. Therefore, the differentiation of asthma into these two subtypes is of importance in the management of the disease. The only way to do this other than the use of FeNO is to do sputum (saliva) analysis, which besides being messy is also time consuming. The FeNO test can be very helpful in this situation. FeNo levels will be high in patients with eosinophil predominant asthma and will be normal in the non-eosinophil predominant subtype. So, by checking the FeNO levels one can decide whether or not to start inhaled steroids.

FeNO levels are very useful in monitoring the response to treatment. In patients who are compliant with treatment and are improving, the FeNo levels should fall. In patients in whom there is a partial improvement, checking serial FeNO levels will help in decision making, i.e. whether to stop, decrease or increase treatment. These levels can used in conjunction with standard spirometry for additional information.

Children are often unable to perform rigorous pulmonary function testing. They find it easier to perform FeNO testing, which is done by gently blowing into the mouthpiece of the measuring device for 10 – 12 seconds. The result is subsequently displayed on the screen in a few seconds.

In summary, FeNo is a non-invasive, easy to perform, quick and reliable test which is an useful adjunct in the management of asthma, especially in children and difficult cases. 

Latest bronchoscopy data

                

We have touched  a triple century... Here is the latest bronchoscopy data from our center.

 



Data current as of  15/8/16.

Amritsar bronchoscopy hands on workshop

A workshop was conducted by the Department of Pulmonary Medicine, Government Medical College, Amritsar on Bronchoscopy and Medical thoracoscopy where I was invited to give talks on TBNA, EBUS-TBNA and Medical Thoracoscopy along with hands-on workshop. Thanks to the organizers for inviting me. It was educational interacting with the post graduate students.

Changing scenario of Sarcoidosis in India

There has been a rapid change in recognition and spectrum of sarcoidosis in India in the last decade. This was considered a rare disease almost till the end of the last century even though the disease was recognized and reported from different places. The change is remarkable considering the fact that the number of publications on the subject has suddenly jumped in the last decade. Of 340 total papers which are listed in PubMed since 1980, about two-third (228) have appeared in the last 10 years. There were only rare publications before 1980. The increase can be attributed to several different causes:

1. True increase in incidence
2. Increased awareness of disease among physicians. Many cases of sarcoidosis were dismissed as tuberculosis in the past.
3. Increased availability of diagnostic tests such as chest CT scanning, fiberoptic bronchoscopy and endo-bronchial ultrasound sound guided fine needle aspiration (EBUS-FNA)
4. Insistence of physicians as well as patients in making a confirmed diagnosis than starting anempiric treatment

Clinical spectrum of sarcoidosis: There is also a change in the spectrum of disease and organ involvement described in the reports of the recent past. Previously, it was mostly the pulmonary involvement i.e. hilar and mediastinal lymphadenopathy which was commonly described. Now, there is a greater recognition of extra-pulmonary involvement including that of the liver, spleen, nervous system and other organs. Moreover, atypical pulmonary presentations such as miliary involvement of lung parenchyma and pleural effusions are frequently reported. It is again a moot question whether this finding is a true change in the spectrum or only an increased recognition because of the factors already listed above.

Sarcoidosis tuberculosis enigma continues to bother physicians in India not only because of similar presentations of both diseases but also since the treatments are different for the two diseases. Corticosteroids, which are used for sarcoidosis may in fact precipitate tuberculosis and are necessarily avoided except in a few specific situations. There is no place to start the treatments for both conditions simultaneously as had been a common practice in the past. It is therefore important to make a firm diagnosis before starting treatment for either condition.

The other major shift which has happened relates to the more frequent use of non-steroidal drugs. Drugs such as methotrexate, hydroxy chloroquin and other immunosuppressants are now available for use for relapse and in the presence of co-morbidities with or without corticosteroid therapy, depending upon the clinical condition.  

S.K. Jindal

Medical Director, Jindal Clinics, Chandigarh